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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and Anal Self-Sampling for Human Papillomavirus Testing in a Transgender and Gender Diverse Population Assigned Female at Birth: Comfort, Difficulty, and Willingness to Use. LGBT Health 2024. [PMID: 38574315 DOI: 10.1089/lgbt.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples. Methods: We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results: Of 137 consenting participants, 101 completed the sample collection and the surveys. The majority of participants reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. Conclusions: TGD individuals AFAB were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for HPV testing could expand access to cancer screening for TGD populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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2
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Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
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Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
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3
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Bursztein Lipsicas C, Hamdan S, Gal G. Emotional Distress, Suicidal Behavior, and Help-Seeking Among Transgender and Gender Diverse People in Israel. Transgend Health 2024; 9:174-179. [PMID: 38585245 PMCID: PMC10998021 DOI: 10.1089/trgh.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose The aim of this study was to evaluate emotional distress, suicidality, and help-seeking among Israeli transgender and gender diverse (TGD) persons. Methods TGD (n=139) and cisgender (n=275) participants reported on suicidal thoughts and behavior (STB), help-seeking behavior, and emotional distress (General Health Questionnaire [GHQ-12]) in an online survey. Results GHQ-12 and STB were significantly higher among TGD compared with cisgender participants. More TGD participants reported seeking help. Conclusion TGD persons reported high levels of emotional distress and STB, suggesting that their needs for mental health care are not met by the Israeli health services.
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Affiliation(s)
| | - Sami Hamdan
- School of Psychology, The Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
| | - Gilad Gal
- School of Psychology, The Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
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4
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Ralston AL, Holt NR, Andrews AR, Huit TZ, Puckett JA, Woodruff N, Mocarski R, Hope DA. Mental Health and Marginalization Stress in Transgender and Gender Diverse Adults: Differences between Urban and Non-Urban Experiences. Psychol Sex Orientat Gend Divers 2024; 11:165-176. [PMID: 38577413 PMCID: PMC10989840 DOI: 10.1037/sgd0000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background Transgender and gender diverse (TGD) individuals face high rates of psychological distress, including depression, anxiety, and suicide risk. Further, TGD individuals living outside of urban areas experience additional disparities compared to their urban counterparts. Minority stress theory states that minority stressors (termed marginalization stressors for this paper), such as experiences of discrimination and internalized transphobia, lead to psychological distress. The current study compared marginalization stressors across rural (population less than 2,500), urban cluster (population between 2,500 and 50,000), and urban (population greater than 50,000) samples and tested the degree to which these stressors account for differences across areas of residence. Methods Participants were 225 TGD individuals who completed an online survey that included measures of depression, anxiety, suicidal ideation marginalization stress, and protective factors. Results In the first model, mental health outcomes, marginalization stressors, and protective factors differed between areas. Urban cluster participants reported experiencing higher levels of depression, anxiety, and suicidal ideation and rural participants reported experiencing higher levels of depression suicidal ideation than urban participants. Both rural and urban cluster participants reported more experiences of several marginalization stressors. In the subsequent path model, indirect effects between area and marginalization stress variables were significant, but urban cluster participants still reported higher depression, anxiety, and suicidal ideation symptoms (p-values < .05). Discussion We demonstrate that marginalization stress processes appear to account for some of the differences between TGD individuals living in urban, rural, and urban cluster areas. The differences between areas largely persist, however, after controlling for marginalization stress, especially when comparing urban with urban cluster areas.
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5
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Kramer R, Aarnio-Peterson CM, Conard LA, Lenz KR, Matthews A. Eating disorder symptoms among transgender and gender diverse youth. Clin Child Psychol Psychiatry 2024; 29:30-44. [PMID: 37343277 PMCID: PMC10748461 DOI: 10.1177/13591045231184917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Compared to cisgender peers, transgender and gender diverse (TGD) youth and adults report elevated eating disorder (ED) symptoms likely related to gender dysphoria and attempts to modify their bodies accordingly. Less is known about the impact on gender-affirming care and ED symptoms. This study aimed to expand on extant research and describe ED symptoms in TGD youth seeking gender-affirming care while exploring potential associations between gender-affirming hormone use and ED symptoms. A total of 251 TGD youth completed the Eating Disorders Examination-Questionnaire (EDE-Q) as part of routine clinical care. ANCOVAs and negative binomial regressions examined differences in ED symptoms among transgender females (identifying as female but assigned male at birth) and transgender males (identifying as male but assigned female at birth). ED severity was not significantly different among transgender females versus transgender males, (p = .09), or associated with gender-affirming hormone use (p = .07). Transgender females receiving gender-affirming hormones reported a greater proportion of objective binge eating episodes compared to those who were not (p = .03). Over a quarter of TGD youth reported engagement in ED behaviors suggesting assessment and intervention related to ED behaviors among TGD youth is imperative since adolescence is a particularly vulnerable period for adolescents and engagement in ED behaviors could lead to full ED development and medical risk.
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Affiliation(s)
- Rachel Kramer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Claire M Aarnio-Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Lee Ann Conard
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Katrina R Lenz
- Department of Child and Adolescent Psychiatry & Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail Matthews
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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6
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Lee G, Hicks DL, Sabol BM, Ellis JD, Brown S, Kcomt L, Agius E, Resko SM. Binge Drinking and Cannabis Use among Transgender and Gender-Diverse Young Adults in Michigan. Health Soc Work 2023; 48:231-239. [PMID: 37616562 DOI: 10.1093/hsw/hlad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/11/2023] [Accepted: 02/15/2023] [Indexed: 08/26/2023]
Abstract
Substance use rates are higher among transgender and gender-diverse people than cisgender people. Rates of substance use are also higher among young adults compared with other age groups. However, little research examines substance use among transgender and gender-diverse young adults. This study examines factors associated with binge drinking and cannabis use among transgender and gender-diverse young adults in Michigan. Participants (N = 78; ages 18-25) completed an online survey that included demographics and substance use and related characteristics. Race, stimulant misuse, and sedative misuse were associated with more frequent binge drinking. Older age and past-year pain reliever misuse were associated with less frequent cannabis use. Past-year stimulant use and using cannabis alone were associated with more frequent cannabis use. These findings suggest that additional marginalized identities may increase the risk for maladaptive substance use. Future research should examine substance use behaviors and correlates to inform interventions among this population.
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Affiliation(s)
- Guijin Lee
- PhD, MSW, is a postdoctoral research fellow, Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, 320 Robison Hall, Memphis, TN 38152, USA
| | - Danielle L Hicks
- PhD, LLMSW, is evaluation project manager, School of Social Work, Wayne State University, Detroit, MI, USA
| | - Brianna M Sabol
- MSW, is research associate, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer D Ellis
- PhD, is assistant professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Suzanne Brown
- PhD, LMSW, is associate professor; School of Social Work, Wayne State University, Detroit, MI, USA
| | - Luisa Kcomt
- PhD, MSW, is assistant professor, School of Social Work, Wayne State University, Detroit, MI, USA
| | - Elizabeth Agius
- BA, is associate director of research; School of Social Work, Wayne State University, Detroit, MI, USA
| | - Stella M Resko
- PhD, MSW, is professor and social work doctoral program director, School of Social Work, Wayne State University, Detroit, MI, USA
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7
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Billard TJ, Cornelius-White JHD, Ozamiz Etxebarria N. Editorial: Anti-transgender prejudice: causes, consequences, and interventions. Front Psychol 2023; 14:1282109. [PMID: 37771806 PMCID: PMC10523383 DOI: 10.3389/fpsyg.2023.1282109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Thomas J. Billard
- School of Communication, Northwestern University, Evanston, IL, United States
- Center for Applied Transgender Studies, Chicago, IL, United States
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8
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Butler W, Kim H, Keuroghlian AS. Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment. LGBT Health 2023; 10:412-415. [PMID: 36971585 DOI: 10.1089/lgbt.2022.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients' psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.
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Affiliation(s)
| | - Heather Kim
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, USA
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9
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Hajek A, König HH, Blessmann M, Grupp K. Loneliness and Social Isolation among Transgender and Gender Diverse People. Healthcare (Basel) 2023; 11:healthcare11101517. [PMID: 37239802 DOI: 10.3390/healthcare11101517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Here, we report the prevalence of loneliness and social isolation and investigate the levels of loneliness and social isolation among transgender and gender diverse people using cross-sectional data from the HH-TPCHIGV study. Using the De Jong Gierveld tool, we assess loneliness, using the Bude and Lantermann tool, we assess perceived social isolation and using the Lubben Social Network Scale, we assess objective social isolation. The prevalence rate of loneliness was 83.3% (perceived social isolation: 77.7%; objective social isolation: 34.4%). Regressions revealed that favorable outcomes (i.e., lower loneliness levels, lower perceived social isolation, and lower objective social isolation) were consistently associated with higher school education. Beyond that, we identify an association between particularly poor health-related factors and higher loneliness and objective social isolation levels. We also report that unemployment was significantly associated with higher levels of perceived social isolation. In conclusion, we show high prevalence rates of loneliness and social isolation among transgender and gender diverse people. Additionally, important correlates (e.g., education, health-related factors, or unemployment) were identified. Such knowledge may provide help to address transgender and gender diverse people at risk for loneliness and social isolation.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Marco Blessmann
- Division of Plastic, Reconstructive and Aesthetic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Katharina Grupp
- Division of Plastic, Reconstructive and Aesthetic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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10
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Wolfe HL, Hughto JMW, Quint M, Hashemi L, Hughes LD. Hepatitis C Virus Testing and Care Cascade Among Transgender and Gender Diverse Individuals. Am J Prev Med 2023; 64:695-703. [PMID: 36759228 PMCID: PMC10121731 DOI: 10.1016/j.amepre.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) prevalence among transgender and gender-diverse individuals ranges from 1.8% to 15.7% versus 1% in the general population. Previous HCV studies inclusive of transgender and gender-diverse individuals primarily rely on convenience-based sampling methods or are geographically restricted. The purpose of this study is to compare the prevalence of HCV diagnoses, testing, and care engagement between transgender and gender-diverse and cisgender individuals. METHODS Using Optum's de-identified Clinformatics® Data Mart Database, in 2022, the unadjusted prevalence of HCV testing among all adults and people who inject drugs from January 2001 to December 2019 was measured. Multivariable logistic regression was used to compare the adjusted odds of HCV diagnoses and care engagement by gender subgroup. RESULTS The overall unadjusted frequency of HCV diagnoses among transgender and gender-diverse individuals was approximately 3 times that of cisgender individuals (1.06% vs 0.38%, p<0.001), including among people who inject drugs (6.36% vs 2.36%, p=0.007). Compared with cisgender women, transfeminine/nonbinary individuals had over 5 times the adjusted odds of a HCV diagnosis and approximately 3.5 times the odds of being tested for HCV. In addition, compared with cisgender women, transfeminine/nonbinary individuals had significantly increased odds of having a HCV‒related procedure (e.g., abdominal ultrasounds, liver biopsies, Fibroscans). Cisgender men had significantly increased odds of receiving HCV medication compared with cisgender women. CONCLUSIONS Although testing was higher among transgender and gender-diverse individuals, the higher overall frequency of HCV diagnoses among transgender and gender-diverse than among cisgender individuals signals persistent health disparities. Interventions are warranted to prevent HCV and increase ongoing testing and treatment uptake among transgender and gender-diverse populations.
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Affiliation(s)
- Hill L Wolfe
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachussetts.
| | - Jaclyn M W Hughto
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, Rhode Island; Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; The Fenway Institute, Fenway Health, Boston, Massachussetts
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachussetts
| | - Leila Hashemi
- Division of Primary Care, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Landon D Hughes
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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11
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Toze M, Gates TG, Hughes M, Dune T, Westwood S, Hafford-Letchfield T, Thepsourinthone J. Social Support in Older Transgender and Gender Diverse Communities in the United Kingdom and Australia: A Comparative Study During COVID-19. J Gerontol Soc Work 2023; 66:381-399. [PMID: 35920781 DOI: 10.1080/01634372.2022.2107135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
While the impact of the COVID-19 pandemic on older people has been recognized, there is limited understanding of its impact on older trans and gender diverse people who often have different experiences of care and support than the general population. This article examines older trans and gender diverse people's experience of social support during the COVID-19 pandemic, based on a comparative mixed method survey administered in Australia and the United Kingdom. Using a non-probability sample of 84 participants who were connected to social media and service organizations in the United Kingdom and Australia, we found some commonalities and differences between experiences in these countries. Some participants were isolated, including almost 1 in 5 participants who said that they did not have someone they could call upon in an emergency. However, participants had rich networks of friends, partners, and family members. Religious organizations and the community also played an important role. Friends were reported as the main emergency contacts and as the main people to whom support is provided. This research supports previous findings that friends of trans and gender diverse people play an important role in well-being.
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Affiliation(s)
- Michael Toze
- Lincoln Medical School, University of Lincoln, Lincoln, UK
| | - Trevor G Gates
- College of Humanities, Arts, and Social Sciences, Colorado State University-Pueblo, Pueblo, Colorado, USA
- School of Law and Society, University of the Sunshine Coast, Sippy Downs, Australia
| | - Mark Hughes
- Faculty of Health, Southern Cross University, Robina, Australia
| | - Tinashe Dune
- School of Health Sciences, Western Sydney University, Penrith, Australia
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12
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Caldarera AM, Vitiello B, Bechis D, Baietto C. Promoting sexual health in transgender and gender diverse adolescents through an online sexuality psychoeducation program for parents: A case study. Clin Child Psychol Psychiatry 2023:13591045231160641. [PMID: 36961756 DOI: 10.1177/13591045231160641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
We describe the implementation and evaluation of an online sexuality psychoeducation group program for parents of young people attending the transgender and gender diverse outpatient service of a pediatric hospital. The 10 participants completed semi-structured pre- and post-intervention questionnaires assessing: whether they had ever discussed with their children about aspects of sexuality, or had the intention of doing it in the future; the level of knowledge and comfort in speaking about these topics; the perceived level of helpfulness of the intervention; and, by using open-ended items, the topics they considered to be most relevant. After attending the program, parents reported they had started talking with their children about issues which previously had been little or not discussed, such as sexting, sexually transmitted diseases, pregnancy, fertility, abuse, and healthy relationships. Participants reported increased levels of knowledge and comfort in addressing these topics and highlighted the importance of being emotionally available to their children. We discuss implications for future intervention development.
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Affiliation(s)
- Angela M Caldarera
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatrics, 154898University of Torino, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatrics, 154898University of Torino, Italy
| | - Daniela Bechis
- Child and Adolescent Neuropsychiatry, 472627Regina Margherita Children's Hospital, Torino, Italy
| | - Chiara Baietto
- Child and Adolescent Neuropsychiatry, 472627Regina Margherita Children's Hospital, Torino, Italy
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13
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Kamal K, Li JJ, Keuroghlian AS. Addressing the Physical and Mental Impacts of Postsurgical Scarring Among Transgender and Gender Diverse People. LGBT Health 2023; 10:259-262. [PMID: 36796004 DOI: 10.1089/lgbt.2022.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Few studies have considered the diverse mental and physical health impacts of scarring among transgender and gender diverse (TGD) patients after medically necessary gender-affirming surgery (GAS). For some TGD patients, post-GAS scarring may exacerbate gender dysphoria. For others, it is a physical representation of authenticity. The dearth of research or validated instruments capturing the diversity of priorities and concerns pre- and post-GAS hinders providers' ability to deliver optimal clinical care throughout the gender-affirmation process and impedes progress for evidence-based policy change regarding post-GAS scar treatment. This article provides suggestions for future research directions to address post-GAS scar-related health needs.
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Affiliation(s)
- Kanika Kamal
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jason J Li
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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14
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Grocott LR, Schlechter TE, Wilder SMJ, O'Hair CM, Gidycz CA, Shorey RC. Social Support as a Buffer of the Association between Sexual Assault and Trauma Symptoms Among Transgender and Gender Diverse Individuals. J Interpers Violence 2023; 38:NP1738-NP1761. [PMID: 35466782 DOI: 10.1177/08862605221092069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The prevalence of experiencing sexual assault is alarmingly high among Transgender and Gender Diverse people (TGD; people whose gender identities and/or expressions are not traditionally associated with their sex assigned at birth) and is associated with various mental health sequalae. Perceived social support has been shown to abate the negative outcomes of sexual assault among cisgender individuals, yet little is known about this association among TGD people, especially which provider of support (i.e., family, friends, or significant others) may be most beneficial. To that end, 191 TGD adults were recruited through Amazon's Mechanical Turk to examine perceived social support as a potential moderator of the association between sexual assault victimization and post-sexual assault trauma symptomology. Results showed an interaction trending toward significance between sexual assault and support from a significant other. Decomposition of this interaction demonstrated that sexual assault was associated with post-assault trauma symptoms when support from a significant other was low (ß = .25, p < .05) but not high (ß = .10, p = .089). The interaction between sexual assault and perceived social support was not significant for perceived support from friends (p = .133) or family (p = .954). Findings highlight the need for additional research on perceived social support as a potential buffering mechanism between sexual assault and post-assault symptomology in TGD people.
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15
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Mitnick S, Goldhammer H, Thompson J, Bruno J, Dunn M, Reisner SL, Keuroghlian AS. Advancing Excellence in Transgender Health: An International Professional Development Conference on Affirming Care for Transgender and Gender Diverse People. J Med Educ Curric Dev 2023; 10:License type: Creative Commons Attribution-NonCommercial license (CC BY-NC 4.0). 23821205231191478. [PMID: 37538103 PMCID: PMC10395158 DOI: 10.1177/23821205231191478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Increasing workforce capacity to provide knowledgeable, skilled, and affirming care for transgender and gender diverse people is critical to reduce health inequities; however, few clinicians receive sufficient training on this topic. This article describes Advancing Excellence in Transgender Health (AETH), an annual international conference that offers continuing professional development on evidence-based medical and behavioral healthcare for transgender and gender diverse people across the lifespan. METHODS Registration data and post-conference evaluation data were descriptively analyzed to assess conference reach, participant satisfaction, and participant intentions to change practice. RESULTS Between 2015 and 2022, AETH trained 2677 participants from all US states and 24 countries. Based on post-conference evaluations, 2017-2022, participant satisfaction was high (mean ≥4.4 on a 5-point scale) on all measures, including meeting learning objectives, quality of presentations, and relevance to practice. Participants reported intentions to: implement new information or skills (86.7%); create or revise protocols, policies, and/or procedures (63.2%); and seek additional information (64.2%). To increase equity, the conference waives fees for transgender and gender diverse participants and offers free online sessions. The conference also holds sessions specifically for transgender and gender diverse participants to promote opportunities for community-building, self-care, and professional networking. CONCLUSION The broad reach of AETH demonstrates a large demand for more continuing professional development on transgender and gender diverse healthcare. This conference has expanded the availability of training designed to increase and enhance clinical workforce capacity to meet the health needs of transgender and gender diverse communities in the US and across the world.
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Affiliation(s)
- Sarah Mitnick
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Hilary Goldhammer
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Jack Bruno
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Mason Dunn
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alex S. Keuroghlian
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Public and Community Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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16
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Streed CG, Perlson JE, Abrams MP, Lett E. On, With, By-Advancing Transgender Health Research and Clinical Practice. Health Equity 2023; 7:161-165. [PMID: 36895704 PMCID: PMC9989508 DOI: 10.1089/heq.2022.0146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 03/06/2023] Open
Abstract
To advance the fields of transgender health research and clinical care and center trans-led scholarship, there must be an acknowledgment of the consolidated power in cisgender hands and the subsequent need to redistribute such power to trans experts and burgeoning trans leaders. To redress the social structures that cause harm and limit opportunities for trans persons to lead, current cisgender leaders can take actions including deferring opportunities to trans persons to ensure a redistribution of power and resources to trans experts. This article presents necessary steps to recruit, collaborate, and elevate trans experts.
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Affiliation(s)
- Carl G Streed
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA
| | - Jacob E Perlson
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Matthew P Abrams
- Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Medicine Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Hanby E, Gazarian PK, Potter J, Jones R, Elhassan N, Tan AS. "I liked just that it was a communal thing": Feasibility and acceptability of engaging with transgender and gender-diverse persons in a digital photovoice research study on commercial cigarette smoking risk and protective factors. Digit Health 2023; 9:20552076231169819. [PMID: 37065542 PMCID: PMC10102937 DOI: 10.1177/20552076231169819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Background Commercial cigarette smoking is the leading modifiable risk factor for more than 16 types of cancer. Over one-third (35.5%) of transgender and gender-diverse (TGD) adults smoke cigarettes compared to 14.9% of cisgender adults. The objective of this paper is to describe the feasibility of enrolling and engaging with TGD persons in a digital photovoice study to examine smoking risk and protective factors through real-world experiences (Project SPRING). Methods The study comprised a purposeful sample of 47 TGD adults aged ≥18 years who currently smoke and live in the United States (March 2019-April 2020). They participated in three weeks of digital photovoice data collection using Facebook and Instagram closed groups. A subsample participated in focus groups to explore smoking risks and protective factors in greater depth. We summarized the enrollment strategies and accrual rates, participant engagement (posts, comments, and reactions) during the photovoice data collection to assess study feasibility, and respondent feedback on acceptability and likability during and after the study. Results Participants were recruited via Facebook/Instagram advertising (n = 33) and via Craigslist/word-of-mouth (n = 14). Costs ranged from $29 via Craigslist/word-of-mouth to $68 per recruited participant via Facebook/Instagram advertising. On average, participants posted 17 pictures of smoking risks/protective factors, commented 15 times on others' posts, and had 30 reactions within their group over 21 days. Participants' rating of the acceptability and likability of the study were positive based on closed- and open-ended feedback. Conclusion The findings of this report will inform future research to engage with TGD community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGD individuals.
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Affiliation(s)
- Elaine Hanby
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Priscilla K. Gazarian
- College of Nursing and Health Sciences, University of Massachusetts
Boston, Boston, USA
| | - Jennifer Potter
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA,
USA
- Division of General Internal Medicine, Beth Israel Lahey Health, Boston, MA, USA
| | - Raquel Jones
- Department of Psychology, University of Massachusetts
Boston, Boston, MA, USA
| | - Noon Elhassan
- Department of Biology, University of Massachusetts
Boston, Boston, MA, USA
| | - Andy S.L. Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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18
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Almazan AN, Benyishay M, Stott B, Vedilago V, Reisner SL, Keuroghlian AS. Gender-Affirming Primary Care Access Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States. LGBT Health 2023; 10:86-92. [PMID: 35960329 DOI: 10.1089/lgbt.2021.0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose: Little is known about the prevalence and predictors of gender-affirming primary care (GAPC) access among rural transgender and gender diverse (TGD) adults. This study therefore sought to characterize the prevalence and predictors of GAPC within a sample of rural TGD adults. Methods: A nonprobability convenience sample (n = 244) of rural TGD adults was recruited across five Northeastern U.S. states (Connecticut, Massachusetts, New Hampshire, New York, Vermont) and completed a health needs assessment from March 2019 to October of 2019. Results: Transgender women and men had higher odds of accessing GAPC than nonbinary and gender diverse respondents. Respondents aged 25-39 had higher odds of accessing GAPC than those 18-24 years old. Conclusion: This study found high prevalence of barriers to GAPC among rural TGD people, highlighting system-level improvement opportunities.
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Affiliation(s)
- Anthony N Almazan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Matan Benyishay
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Brooke Stott
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | | | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Pinciotti CM, Wadsworth LP, Miron LR, Riemann BC, Leonard RC. Transgender and Gender Diverse Patients in Intensive Mood Disorder Treatment: A Comparative Examination of Clinical Presentation and Treatment Outcomes. Behav Ther 2022; 53:1062-76. [PMID: 35987536 DOI: 10.1016/j.beth.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022]
Abstract
Individuals who are transgender and gender diverse (TGD) are more likely to suffer from and to seek mental health services for mood disorders. Some literature suggests that TGD individuals, because of pervasive and systemic minority stress, may have more complex clinical presentations (i.e., psychiatric conditions and severity of symptoms) and may benefit from empirically based treatments to a lesser degree than their cisgender peers. However, research has yet to examine individuals who are TGD receiving treatment in specialized, intensive mood disorder treatment despite the propensity for them to be diagnosed with and treated for mood disorders. Using a sample of 1,326 adult patients in intensive mood disorder treatment (3.8% TGD), the clinical presentation and treatment outcomes were compared between patients who are TGD and cisgender. Contrary to previous research, TGD patients were largely similar if not healthier than their cisgender counterparts, including similar depression severity, quality of life, emotion dysregulation, and behavioral activation, and less severe rumination at admission. Despite similar to better reported mental health symptoms, TGD patients were diagnosed with more psychiatric conditions overall, including greater prevalence of social anxiety and neurodevelopmental diagnoses. Those who are TGD did not experience attenuated treatment response as predicted. Findings suggest that patients in intensive mood disorder treatment who are TGD may be more resilient than previously assumed, or supports may have increased to buffer effects of stigma on mental health, and emphasize the need to exercise discretion and sensitivity in diagnostic practices to prevent over-diagnosis and pathologizing of TGD individuals.
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20
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Reisner SL, Benyishay M, Stott B, Vedilago V, Almazan A, Keuroghlian AS. Gender-Affirming Mental Health Care Access and Utilization Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States. Transgend Health 2022; 7:219-229. [PMID: 36643056 PMCID: PMC9829153 DOI: 10.1089/trgh.2021.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose Transgender and gender diverse (TGD) populations are burdened by substantial mental health disparities. The mental health needs of TGD people in rural areas remain largely unknown. This study sought to characterize gender-affirming mental health service access and utilization in a sample of TGD adults from predominantly rural areas in the northeastern United States. Methods A nonprobability sample of 241 TGD adults was recruited from 25 counties across Connecticut, Massachusetts, New Hampshire, New York, and Vermont. Participants completed a cross-sectional computer-administered survey, including self-reported mental health and mental health care needs. Bivariate and multivariable models were fit to examine the association of mental health service utilization with: sociodemographics; health insurance coverage; name and gender marker change; mental health symptoms; perceived stigma; mental health, substance use disorder, and somatic diagnoses; and violence victimization. Primary outcomes were utilizing either psychotherapy or psychopharmacology, both, or neither service. Results Around 68.9% of the sample resided in rural areas. Fifty-one percent of respondents currently utilized at least one gender-affirming mental health service (48.5% psychotherapy, 18.7% psychopharmacology, 16.2% both services). Common barriers to gender-affirming mental health services were lack of trained providers, lack of mental health integration with primary care, financial costs, difficulty scheduling, distances that were too far, and transportation issues. Factors most important in choosing a mental health care provider were health insurance, gender-affirming care, rapport, and availability. Conclusion Access to and utilization of gender-affirming mental health services was suboptimal in this sample. Achieving mental health equity will require addressing barriers experienced by TGD people in rural areas.
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Affiliation(s)
- Sari L. Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Matan Benyishay
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Brooke Stott
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | | | - Anthony Almazan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Address correspondence to: Alex S. Keuroghlian, MD, MPH, The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA,
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21
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Boguszewski KE, Woods S, Ducar DM, Taylor JF. Transgender and Gender Diverse Fertility Choices: Supporting the Decision-Making Process for Adolescents and Young Adults. J Pediatr 2022; 240:256-264.e1. [PMID: 34717962 DOI: 10.1016/j.jpeds.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To qualitatively examine the fertility-related decision making process of transgender and gender diverse (TGD) adolescents and young adults (AYAs) and their parents, in the setting of pursing gender affirming treatments. STUDY DESIGN Twenty-five TGD AYAs and 6 parents of TGD AYAs participated in a focus group or individual semistructured interviews focused on participants' experience learning about the effects of gender affirming treatments on fertility as well as the process of making a fertility preservation decision. Using open coding, data were analyzed in an iterative process identifying emerging themes and relationships. A decisional satisfaction score was collected and/or coded for each participant. RESULTS Four broad themes related to the decision-making process were identified: (1) Critical steps include awareness, gathering information, and conversations; (2) External constraints limit choices; (3) Expanding the conversation beyond preservation; and (4) Emotional distress, conflict, and decisional satisfaction. Despite reporting emotional distress or conflict during the decision, TGD AYAs and parents of TGD AYAs generally reported a high level of satisfaction with their fertility preservation decision. CONCLUSIONS There are specific ways health care professionals and family members can support TGD AYAs in their fertility-related decision making process. Decisional satisfaction was common, regardless of whether TGD AYAs chose to pursue fertility preservation or not.
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Affiliation(s)
| | - Sarah Woods
- SUNY Upstate Medical University, Syracuse, NY
| | - Dallas M Ducar
- Transhealth Northampton, Northampton, MA; Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA; Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA; College of Science, Northeastern Univeristy, Boston, MA; School of Nursing, Columbia University, New York, NY
| | - Julia F Taylor
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
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22
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Price SF, Puckett JA, Mocarski R. The Impact of the 2016 Presidential Elections on Transgender and Gender Diverse People. Sex Res Social Policy 2021; 18:1094-1103. [PMID: 34925634 PMCID: PMC8673739 DOI: 10.1007/s13178-020-00513-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND With Trump's presidency came a rise in the oppression of transgender and gender diverse (TGD) people, as the nation witnessed a removal of protections for TGD people. METHOD We examined the daily experiences of 181 TGD individuals (ages 16-40, M age = 25.6) through their reflections about daily stressors over the course of 8 weeks (data collected fall 2015-summer 2017), some of which reflected shifts during the election period. RESULTS During 2016 presidential election, participants reported a rise in marginalization stress and the subsequent impact on safety, mental health, and well-being. There were three emergent themes: External Rejection and Stigma from Dominant Culture; Supporting the TGD Community; and Fear for the Self and Development of Proximal Stressors. CONCLUSION In line with marginalization stress theory, participants vocalized the progression from exterior stigmatization to proximal stressors and their heightened sense of vigilance and fear of the dominant culture.
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Affiliation(s)
- Sarah F Price
- College of Communication and Information Sciences, University of Alabama, 901 University Blvd, Tuscaloosa, AL 35401
| | - Jae A Puckett
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI 48824
| | - Richard Mocarski
- Division of Research, University of Nebraska at Kearney, 2134 Warner Hall, Kearney, NE 68845
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23
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Holt NR, Ralston AL, Hope DA, Mocarski R, Woodruff N. A Systematic Review of Recommendations for Behavioral Health Services for Transgender and Gender Diverse Adults: The Three-Legged Stool of Evidence-Based Practice is Unbalanced. Clin Psychol (New York) 2021; 28:186-201. [PMID: 34456519 PMCID: PMC8386449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care.
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24
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Lim G, Waling A, Lyons A, Pepping CA, Brooks A, Bourne A. Trans and Gender-Diverse peoples' experiences of crisis helpline services. Health Soc Care Community 2021; 29:672-684. [PMID: 33704863 DOI: 10.1111/hsc.13333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 10/05/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
Crisis helplines are typically easily accessible and deliver interventions in a timely manner, regardless of geographical location. The efficacy and user experiences of these services are the subject of considerable interest within the field, but the experiences of trans and gender-diverse individuals remain unexplored despite high rates of mental ill health being documented in this population. A total of 134 trans and gender-diverse Australians were surveyed about their experiences of personal crises and of utilising crisis helplines. Within our sample, 84.2% (n = 113) of participants recognised at least one service - however, only 32.8% (n = 44) utilised a service to cope with a personal crisis. Participants cited poor recognition and understanding of the challenges specific to trans and gender-diverse individuals among helpline workers as a primary reason for avoiding these services, and articulated needs which were a poor fit for the one-off intervention model commonly employed by helpline services. In order for helpline services to be viable avenues of support for trans and gender-diverse individuals during a personal crisis, helpline workers must be sufficiently equipped to work with trans and gender-diverse callers and to facilitate their enrolment in 'traditional' mental health services.
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Affiliation(s)
- Gene Lim
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Anna Brooks
- Lifeline Research Foundation, Canberra, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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25
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Holt NR, Huit TZ, Shulman GP, Meza JL, Smyth JD, Woodruff N, Mocarski R, Puckett JA, Hope DA. Trans Collaborations Clinical Check-In (TC 3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services. Behav Ther 2019; 50:1136-1149. [PMID: 31735248 PMCID: PMC7405917 DOI: 10.1016/j.beth.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 01/07/2023]
Abstract
One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement-based care, given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in health care. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final 18-item version was administered to 215 TGD adults (75 transfeminine, 76 transmasculine, 46 nonbinary, 18 unknown; mean age of 30 with a range of 19 to 73), who were recruited for an online study, with other questionnaires assessing negative affect, well-being, gender dysphoria, gender minority stressors, and resilience. Higher scores on the TC3 (indicating better adjustment and comfort with gender) were generally associated with lower depression, anxiety, minority stress, and gender dysphoria and greater life satisfaction, body congruence, and positive aspects of being TGD such as pride in identity and community belongingness. These results support the validity of the TC3 as a brief measure to be used as a clinical tool for TGD people receiving mental health services. Additional research is needed on the reliability and validity of the TC3 across multiple time points to determine utility as a progress monitoring measure. The TC3 should also be further validated with more culturally diverse samples.
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